Challenges in co-designing an intervention to increase mobility in older patients: a qualitative study

Building the OAChangeMap to Improve the Service Delivery of the New South Wales Osteoarthritis Chronic Care Program: A Worked Example of Using a Codesign Framework

OBJECTIVE

The Osteoarthritis Chronic Care Program (OACCP) has been implemented in Australian public hospitals to deliver best evidence osteoarthritis (OA) care. It is important to ensure that the OACCP continues to deliver evidence-based OA care as intended. We aimed to identify barriers and enablers to delivering the OACCP, prioritize the barriers, and generate strategies to address them.

METHODS

This study provides a worked example of a seven-step theory-informed codesign framework. We invited OACCP coordinators to participate in semistructured interviews (analyzed thematically) and complete a questionnaire to identify barriers and enablers to delivery of the OACCP. We then invited a broader group of stakeholders (OACCP coordinators, health managers, policy makers, consumers, and researchers) to prioritize the barriers via a short survey (survey 2). We held five codesign workshops in which we mapped the priority barriers to the Theoretical Domains Framework and developed strategies to address them.

RESULTS

Sixteen coordinators were interviewed, and the main barriers identified were as follows: (1) patients often have beliefs that are inconsistent with best evidence care, (2) there are aspects of clinical care that are not delivered optimally, and (3) system-level factors are a barrier to optimal patient care and sustainability of the OACCP. We codesigned a plan for action with patient educational materials, shared decision-making tools, and health professional education and training.

CONCLUSION

Our worked example of codesign used a theory-based, data-driven approach with key stakeholders, identified and prioritized barriers to the delivery of the OACCP, acknowledged enablers, and generated a plan for feasible strategies to improve the program.

Older family caregivers and health professionals of adults with intellectual disabilities: Qualitative results of the first-phases of the adaptation of the Savvy Caregiver Program through the ADAPT-ITT model

Adults with intellectual disabilities are living longer, leading to an increasing need for older family caregivers to provide long-term care. To date, many studies have focused primarily on interventions to support caregivers of children with disabilities and elderly with dementia. For this reason, this study focuses on adapting the Savvy Caregiver Programme. The adaptation was conducted through the ADAPT-ITT model, and involved 15 family caregivers and 22 health professionals. The study addresses the initial phases of the model. The first phase consisted of a needs analysis of family caregivers. The second phase involved a decision-making process regarding the intervention. The third phase employed a pre-testing methodology to assess the original intervention. Later phases, which are not reported in this study, help to evaluate the effectiveness of the adapted intervention. Caregivers and professionals expressed interest in the intervention, although it only partially addressed their reported needs. The program was originally developed for caregivers of elderly with dementia. Some of the needs it addresses are relevant to this population, but other aspects do not align. As a result, the program was adapted to better meet the needs of older family caregivers (over 60 years of age) of adults with intellectual disabilities. Key differences include the duration of caregiving and the level of expertise: in the case of disabilities, caregiving is often lifelong, and caregivers tend to be experts in disability. In conclusion, the study, which used a co-creation approach, underscores the need for a deeper understanding of caregiving for adult with disability.

Exploring the status of online social support for older adults with cancer: A scoping review

INTRODUCTION

The number of new cancer cases among older adults is rising, yet their social support needs remain unmet due to diminishing social networks with age. Since the COVID-19 pandemic, online technologies have provided increased opportunities for social support for this demographic via digital platforms such as online peer support groups, online communities, and chat rooms. This scoping review explores the current state of the use of online social support for older adults with cancer.

MATERIALS AND METHODS

This scoping review was based on the Arksey and O'Malley methodological framework with the extension proposed by Levac and colleagues. The protocol was registered on Open Science Framework (OSF). PubMed, Elsevier Embase (including Medline), and EBSCO CINAHL Complete were searched to identify eligible studies. The review findings were presented in a narrative synthesis.

RESULTS

Out of 6542 references, we included three studies. Two studies investigated older patients' preferences for different types of peer support through surveys and questionnaires, and the third examined the feasibility of an online platform for older women with breast cancer. Barriers identified include a lower interest and familiarity, sense of involvement, and emotional impact of a new diagnosis. However, factors such as socio-demographic characteristics and positive motivation for using online peer support act as facilitators.

DISCUSSION

This scoping review is the first to examine the literature on online social support specifically for older adults with cancer, revealing a paucity of research. Further research is required to understand the potential need and interest in online social support for this population, especially as technology becomes more integrated into daily life post-COVID.

The trends of patient engagement in a co-production healthcare services: a insights from a bibliometric analysis

PURPOSE

Co-production improves the quality of healthcare services by prioritizing patient-centred care and ensuring optimal implementation. Current patient participation research have primarily concentrated on the co-production stages, despite patient participation being the central emphasis of its implementation. A study conducted analysed four specific attributes of patient participation, with patient engagement specifically emphasizing the interactions between patients and healthcare workers. Several studies have concluded that the interaction between the two actors is inefficient. This article examines current study trends concerning patient participation and identifies knowledge gaps from these studies.

DESIGN/METHODOLOGY/APPROACH

This study used bibliometric analysis. This study used VOSviewer software for bibliometric analysis. The Scopus database contained 398 publications about patient participation in co-production in healthcare, which served as the basis for the analysis.

FINDINGS

The study on patient engagement in a co-production context for healthcare had grown fast in recent years. Patient-centred approach and patient-centred care were two important things in patient engagement. Several factors influenced the implementation of patient engagement: attitude, ability, awareness, responsibility and knowledge. It is still uncommon to do research on the measurement of output and results from patient engagement implementation. Studies on instruments for measuring these two factors, particularly in a quantitative manner, are still few.

RESEARCH LIMITATIONS/IMPLICATIONS

Various recommendations have been put forward for additional investigation. Firstly, further examination of outcome measurement in patient engagement is necessary, given the lack of decisive instruments available. Secondly, examining the most influential factors on patient engagement in co-production in healthcare. Thirdly, a more thorough analysis is needed regarding the dimensions of co-production, considering that some dimensions overlap, such as the activation and empowerment dimensions, which are really carried out during engagement. The researcher acknowledges the inherent limitations of bibliometric studies, including the dependence on the Scopus databases for extracting data and the choice of search phrases. Furthermore, conducting a systematic literature review may be necessary to thoroughly examine and delineate the research topics, methodologies and outcomes of this study.

ORIGINALITY/VALUE

This study updates us on patient engagement study trends and establishes a framework for implementing patient engagement in healthcare services.

'Motivating Implicit Chinese to Express Themselves Is the Biggest Barrier': A Qualitative Study of Chinese Researchers' Perceptions of Barriers and Facilitators to Patient Engagement in Research

BACKGROUND

Patient Engagement in Research (PER) has demonstrated benefits for patients, researchers and research outcomes. However, China lacks substantial experience in implementing PER. The implementation of PER in China faces unique challenges due to social-cultural differences. This study explores the perspectives of Chinese researchers to identify barriers and facilitators, aiming to guide future PER initiatives and enhance the role of patients in research.

METHOD

Purposive sampling was employed to recruit clinical researchers with diverse healthcare backgrounds in China. Semi-structured interviews, conducted by a qualified researcher, followed interview guidelines derived from a literature review and pilot study modifications. Thematic analysis was applied using QSR Nvivo 8.0.

RESULTS

A total of 13 participants were included. Five main themes were identified from interview: (1) selection of patients for research engagement, (2) strategies to alleviate the patient burden in implementing PER, (3) strategies to encourage patients for active expression, (4) benefits to attract patient engagement and (5) researcher's preparation.

CONCLUSION

The cultural trait of 'reservedness' in Chinese culture hinders active expression by patients in the research engagement process. Researchers tend to recruit patients with specific characteristics and emphasize the importance of aligning benefits with patient values to motivate engagement. Addressing patient burden is crucial, and researchers should be well-prepared before PER. These findings underscore the necessity of adopting culturally adapted strategies in PER to effectively address specific challenges.

PATIENT OR PUBLIC CONTRIBUTION

The public participated in the interpretation of the interview results, enriching our understanding of the results.

Supporting resident-centred decision-making about transitions from long-term care homes to hospital: a qualitative study protocol

INTRODUCTION

Burdensome care transitions may occur despite clinicians' engagement in care planning discussions with residents and their family/friend care partners. Conversations about potential hospital transfers can better prepare long-term care (LTC) residents, their families and care providers for future decision-making. Lack of such discussions increases the likelihood of transitions that do not align with residents' values. This study will examine experiences of LTC residents, family/friend care partners and staff surrounding decision-making about LTC to hospital transitions and codesign a tool to assist with transitional decision-making to help prioritise needs and preferences of residents and their care partners.

METHODS AND ANALYSIS

This study will use semi-structured needs assessment interviews (duration: 1 hour), content analysis of existing decision support and discussion tools and a codesign workshop series (for residents and care partners, and for staff) at three participating LTC home research sites. This qualitative work will inform the development of a decision support tool that will subsequently be pilot tested and evaluated at three partnering LTC homes in future phases of the project. The study is guided by the Person-centred Practice in Long-term Care theoretical framework. Interview audio recordings will be transcribed verbatim and analysed using reflexive thematic analysis. Participants will be recruited in partnership with three LTC homes in Ottawa, Ontario. Eligible participants will be English or French speaking residents, family/friend care partners or staff (eg, physicians, nurses and personal support workers) who have experienced or been involved in a transition from LTC to hospital.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Bruyère Health Research Ethics Board (#M16-23-030). Findings will be (1) reported to participating and funding organisations; (2) presented at national and international conferences and (3) disseminated by peer-review publications.

Creating a sense of place when implementing a new emergency department in Denmark: a qualitative study

BACKGROUND

Physical locations play an essential yet often overlooked role in healthcare implementation processes. Implementation Science frameworks such as the Theoretical Domains Framework, the Consolidated Framework for Implementation Research, and the Implementation in Context framework acknowledge the importance of the physical environment, but they often treat it as a passive backdrop for change. However, from a cultural geographic perspective, spaces and places are dynamic, influencing behavior, social structures, and the acceptance of new practices. This study aims to explore how managers and emloyees develop a sense of place in a new emergency department (ED) and how these spatial dynamics influence the implementation process.

METHODS

This study used a multi-sited ethnographic design, tracking the implementation process across multiple hospital locations from 2019 to 2023. Fieldwork was conducted in settings such as management meetings, micro-simulation training, and tours of the new ED construction site. A total of 53 participants, including managers, nurses, and physicians from 12 specialized departments, were purposively selected. Data were collected through ethnographic field notes (750 single-spaced pages) and semi-structured interviews averaging 39 min. Analysis was guided by situational analysis and cultural geography, integrating human and nonhuman elements. An overall inductive approach was used to develop theory from observations through analysis, applying a coding system to identify key themes related to spaces, places, traces, and sense of place.

RESULTS

Five themes emerged regarding the development of a sense of place: (1) comfort, influenced by physical elements such as daylight and indoor climate; (2) spatial organization, affecting collaboration, workflow, and professional identity; (3) familiarity, highlighting cultural practices and equipment in fostering belonging; (4) time, where construction delays enabled deeper emotional engagement; and (5) involvement, showing that initial criticism transformed into stronger ownership through increased engagement.

CONCLUSION

This study highlights the importance of a sense of place during pre-implementation of new physical locations in healthcare. Factors such as comfort, spatial organization, familiarity, time, and involvement are key to participants' development of a strong sense of place in the new ED. These insights are crucial for designing implementation processes that address both physical and emotional needs, influencing outcomes such as acceptability, adoption, and sustainability.

Codesign with citizens to prevent cardiometabolic diseases in disadvantaged neighbourhoods: an interview study on needs and priorities among stakeholders in Sweden

OBJECTIVES

Cardiometabolic diseases are a global health concern, affecting socioeconomically disadvantaged groups more adversely. Effective public health interventions targeting preventable risk factors like physical inactivity and unhealthy diets are needed. Codesign with citizens presents a promising opportunity for developing context-relevant and population-relevant interventions, with high chances of adoption by the target population. This study aimed to understand the needs and priorities of key stakeholders to engage in codesign with citizens for the prevention of cardiometabolic diseases, focusing on socioeconomically disadvantaged groups in Uppsala, Sweden.

DESIGN

A qualitative case study was conducted using semistructured interviews with stakeholders working with prevention and and promotion of healthy and active living in public, private and civil society sectors. The interviews were audio recorded, transcribed verbatim and analysed using reflexive thematic analysis.

SETTING

Uppsala, Sweden.

PARTICIPANTS

A total of 24 participants were purposively sampled.

RESULTS

While participants described the critical value of participatory processes to achieve goals in their work, they struggled to prioritise prevention efforts over time. This adversely affected the continuity of public health interventions and collaborations with other stakeholders. They also described resistance towards inclusive processes from within their organisations, as they were seen as time-consuming and generating unpredictable outcomes. Additionally, the persistence of a siloed system structure of organisations and the risks associated with accessing target populations through local intermediaries added to the challenges.

CONCLUSION

This study highlights the lack of integration of organisational values and functions within and across organisations, hindering cross-sector collaboration and citizen engagement in prevention and health promotion activities. Additionally, the low priority of prevention and ineffective use of codesign hampers continuity and long-term perspectives of prevention and health promotion. To create more conducive conditions for codesign, facilitating intersectoral activities and more inclusive processes is needed and may be enabled by explicit and systematic support.

Development of a Web Platform to Facilitate the Implementation and Evaluation of Health Promoting Schools: Protocol for a Double Diamond Design Approach

BACKGROUND

Health Promoting Schools (HPS) have emerged as a powerful framework to promote healthy behaviors in many countries. However, HPS still present several challenges, highlighting the excessive workload involved in the accreditation, design, implementation, and evaluation processes. In this sense, a resource to facilitate the implementation processes may have a positive impact on the support of HPS.

OBJECTIVE

The aim of this study was to describe the co-design processes undertaken and resulting learnings to develop the Red Escuelas Promotoras de Salud (network of health promoting schools; REDEPS)-Gestion platform to facilitate the accreditation, design, implementation procedures, and evaluation processes of the Aragon's Health-Promoting School Network.

METHODS

The Double Diamond Design Approach was used to co-design this web-platform. The different stakeholders that participated in this co-design, progressed through a 4-stage reflective phase, to discover, define, develop, and deliver the REDEPS-Gestion platform.

RESULTS

Participants agreed that the functions of the REDEPS-Gestion platform should permit the management of both the educational centers and the administration such as accreditation processes, definition and review intervention projects, and preparation and review of the different progress reports to evaluate the HPS. Despite co-design being a well-established approach to creative practice, especially within the public sector, some challenges emerged during the co-design process, such as engaging and facilitating stakeholders' participation or the complexity of combining the interests of all stakeholders. This approach allowed us to identify the main barriers for future users and implement platform improvements.

CONCLUSIONS

We hope that the REDEPS-Gestion platform will therefore be able to contribute to facilitating the implementation of HPS. The Double Diamond Design Approach used to co-design this web platform was an efficient and feasible methodological design approach. The REDEPS-Gestion platform will facilitate HPS implementation in Aragon as well as all the processes involving HPS. Future work will determine its effectiveness in improving HPS implementation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52110.

Reflections on co-producing an obesity-prevention toolkit for Islamic Religious Settings: a qualitative process evaluation

BACKGROUND

Islamic leaders, staff, and Muslim parents in the UK are supportive of healthy lifestyle intervention delivery through Islamic Religious Settings. Such interventions are necessary given high obesity rates in British South Asian (40%) compared to White British (32%) children of equivalent age. Co-production can facilitate the development of culturally appropriate health interventions, however it can be theoretically and practically challenging, and evaluation of co-production within an Islamic Religious Setting context is lacking. The aim of this study was to examine the feasibility and acceptability of taking a co-production approach to develop an obesity-prevention toolkit for Islamic Religious Settings.

METHODS

An obesity-prevention toolkit for use in Islamic Religious Settings, incorporating physical activity, healthy diet, and organisational change, has been co-produced to be evidence-informed and contextually relevant. A qualitative process evaluation was employed to examine experiences of co-production. Semi-structured interviews (n = 15) and a focus group (n = 5) were conducted with toolkit co-production stakeholders, e.g., subject experts, an Islamic scholar, and Islamic Religious Setting staff. Transcripts were analysed inductively using reflexive thematic analysis.

RESULTS

The analysis revealed four major themes regarding stakeholders' experiences of co-producing a childhood obesity-prevention toolkit for Islamic Religious Settings. These themes are: (1) attitudes towards obesity-prevention through Islamic Religious Settings, (2) benefits of co-production including capacity building and ownership (3) negotiating involvement, power, and perspectives within the co-production process, and (4) the complexities of effective communication in co-production.

CONCLUSION

This study adds to the evidence-base in support of delivering health promotion through faith settings. Taking a co-production approach to develop an obesity-prevention toolkit for Islamic Religious Settings provided benefit to the toolkit product and local stakeholders. The toolkit is currently being implemented across Bradford, UK and there is potential to adapt the toolkit to other geographical contexts, and for evaluating effectiveness for preventing obesity in British Muslim families.

Developing a low back pain guideline implementation programme in collaboration with physiotherapists and chiropractors using the Behaviour Change Wheel: a theory-driven design study

BACKGROUND

Low back pain is still the leading cause of disability and societal burden, with 619 million prevalent cases worldwide in 2020. Most countries produce clinical guidelines to support healthcare professionals in evidence-based care regarding low back pain. However, several studies have identified relatively poor uptake of guidelines. Tailored strategies to facilitate the implementation of guidelines have been argued to increase uptake. This study aimed to develop a contextually tailored implementation programme to enhance evidence-based low back pain care among Danish physiotherapists and chiropractors in primary care.

METHODS

A theory-driven implementation programme development study was conducted using the Behaviour Change Wheel, with high healthcare professional involvement. Data collection included four workshops with seven physiotherapists and six chiropractors from primary care clinics. The development process consisted of [1] establishing a theoretical frame, [2] involving participants, [3] understanding the behaviour, [4] designing the implementation programme, and [5] final implementation programme.

RESULTS

The target behaviours selected (guideline recommendations) for the implementation programme were (i) screening of psychosocial risk factors and (ii) offering patient education. The barriers and facilitators for the selected behaviours were described and linked to intervention functions and behavioural techniques. Finally, the implementation programme comprised five strategies: webinars, e-learning videos, communication exercises, peer learning, and group dialogue meetings. In addition, the programme consisted of implementation support: champions, a physical material folder, a weekly email reminder, a specially designed website and a visit from an implementation consultant. An essential element of the overall programme was that it was designed as a step-by-step implementation process consisting of 16 h of education and training distributed over 16 weeks.

CONCLUSIONS

A programme for implementing low back pain guideline recommendations was developed based on behaviour change theory and four co-design workshops involving healthcare professionals to overcome the contextually identified barriers. A theory-driven approach involving healthcare professionals was useful in identifying relevant target behaviours and tailoring the programme to consider contextual barriers and facilitators for implementation. The effectiveness of the final implementation programme will be evaluated in the project's next phase.

TRIAL REGISTRATION

Central Denmark Region, Registered November 11, 2021, act no. 1-16-02-93-19.

How the expert nursing role was used to facilitate the co-design of a patient interview study

BACKGROUND

Co-design is a research method that seeks to engage service users in research. The approach fosters inclusivity and shared power by having researchers and research participants work together for some or all of a study.

AIM

To describe the experience of co-designing a patient interview study from the perspective of an expert stoma nurse, using a case-study approach and reflexive methods.

DISCUSSION

Valuing expert patients' experiences when conducting research about them enabled patients to be trained as participant researchers to co-design and undertake a patient interview study. The co-design process enabled the researcher to develop a greater recognition of the fact that experience of looking after people with stomas does not equate to expertise in knowing what it is like to have a stoma. This enriched her research experience and increased the authenticity of the study.

CONCLUSION

Co-designing a study with service users creates challenges for nurse researchers. They must pay attention to relational changes, time, planning and organisation to ensure that they conduct their research rigorously and ethically, and safeguard the co-researchers and other participants from potential risks.

IMPLICATIONS FOR PRACTICE

Co-designing research is critical for developing effective, patient-centred bodies of evidence. Nurse researchers can play a critical role but must be prepared to shift from directive to participatory methods to identify appropriate, patient-focused improvements.

Co-design for stroke intervention development: Results of a scoping review

BACKGROUND

Co-design methodology seeks to actively engage end-users in developing interventions. It is increasingly used to design stroke interventions; however, limited guidance exists, particularly with/for individuals with stroke who have diverse cognitive, physical and functional abilities. Thus, we describe 1) the extent of existing research that has used co-design for stroke intervention development and 2) how co-design has been used to develop stroke interventions among studies that explicitly used co-design, including the rationale, types of co-designed stroke interventions, participants involved, research methodologies/approaches, methods of incorporating end-users in the research, co-design limitations, challenges and potential strategies reported by researchers.

MATERIALS AND METHODS

A scoping review informed by Joanna Briggs Institute and Arksey & O'Malley methodology was conducted by searching nine databases on December 21, 2022, to locate English-language literature that used co-design to develop a stroke intervention. Additional data sources were identified through a hand search. Data sources were de-duplicated, and two research team members reviewed their titles, abstracts and full text to ensure they met the inclusion criteria. Data relating to the research objectives were extracted, analyzed, and reported numerically and descriptively.

RESULTS

Data sources used co-design for stroke intervention development with (n = 89) and without (n = 139) explicitly using the term 'co-design.' Among studies explicitly using co-design, it was commonly used to understand end-user needs and generate new ideas. Many co-designed interventions were technology-based (65%), and 48% were for physical rehabilitation or activity-based. Co-design was commonly conducted with multiple participants (82%; e.g., individuals with stroke, family members/caregivers and clinicians) and used various methods to engage end-users, including focus groups and workshops. Limitations, challenges and potential strategies for recruitment, participant-engagement, contextual and logistical and ethics of co-designed interventions were described.

CONCLUSIONS

Given the increasing popularity of co-design as a methodology for developing stroke interventions internationally, these findings can inform future co-designed studies.

Using participatory research to co-produce an education and training e-resource to support care home staff to meet the sexuality, intimacy and relationship needs of care home residents with and without dementia

Aim

To present the methodological approach and research methods chosen in a research study designed to enable the collaborative creation of an education and training e-resource designed to facilitate and support care home staff to address the sexuality, intimacy and relationship needs of older care home residents.

Design

Co-production using community-based participatory approach.

Methods

Four participatory workshops with care home staff, residents and their significant others.

Results

Workshops 1 and 2 identified and developed real-world case scenarios related to sexuality, intimacy and relationship needs and identified care staff training needs in this area. Then workshop 3 provided valuable feedback on the prototype training e-resource, and the final workshop identified care home staff engagement with and implementation of the e-resource in practice.

Conclusion

The findings provide evidence that using participatory approaches, such as co-production, to develop education and training resources in a sensitive subject area with care home residents, significant others, carers and care home staff, was a useful approach in engaging a vulnerable population group, in a sensitive area. However, this approach is not without challenges in care home communities.

Enhancing the appropriateness of eyecare delivery: the iCaretrack approach

Optometrists play an integral role in primary eyecare services, including prevention, diagnosis, and management of acute and chronic eye conditions. Therefore, it remains essential that the care they provide be timely and appropriate to ensure the best patient outcomes and optimal utilisation of resources. However, optometrists continuously face many challenges that can affect their ability to provide appropriate care (i.e., the care in line with evidence-based clinical practice guidelines). To address any resulting evidence-to-practice gaps, programs are needed that support and enable optometrists to adopt and utilise the best evidence in clinical practice. Implementation science is a field of research that can be applied to improving the adoption and maintenance of evidence-based practices in routine care, through systematic development and application of strategies or interventions to address barriers to evidence-based practice. This paper demonstrates an approach using implementation science to enhance optometric eyecare delivery. A brief overview of the methods used to identify existing gaps in appropriate eyecare delivery is presented. An outline of the process used to understand the behavioural barriers responsible for such gaps follows, involving theoretical models and frameworks. The resulting development of an online program for optometrists to enhance their capability, motivation, and opportunity to provide evidence-based eyecare is described, using the Behaviour Change Model and co-design methods. The importance of and methods used in evaluating such programs are also discussed. Finally, reflections on the experience and key learnings from the project are shared. While the paper focuses on experiences in improving glaucoma and diabetic eyecare in the Australian optometry context, this approach can be adapted to other conditions and contexts.

Patient and public involvement in Nordic healthcare research: a scoping review of contemporary practice

BACKGROUND

Over the past decades, there has been a growing international interest in user involvement in healthcare research. However, evidence on the management and impact of patient and public involvement in Nordic healthcare research remains limited.

OBJECTIVE

The aim was to explore and delineate the current state, practice, and impact of patient and public involvement in healthcare research across different areas of healthcare and patient populations in the Nordic countries.

METHODS

We conducted a scoping review using nine scientific databases and gray literature from 1992-2023. Sources were categorized as empirical or non-empirical. We used the Guidance for Reporting Involvement of Patients and the Public Short Form 2 checklist for reporting of patient and public involvement in healthcare research and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

RESULTS

A total of 56 publications were included, consisting of 39 empirical and 17 non-empirical sources. Gray literature varied among countries and institutions encompassing different types of documents. We found an increase in the number of publications on patient and public involvement in Nordic healthcare research. This was evidenced by the growing number of references and institutional initiatives intended at involving the public, indicating the increasing emphasis on patient and public involvement in Nordic healthcare research. The terminology used to describe patient and public involvement varied over time. However, there has been a gradual narrowing down of terms as the concept of PPI has become more integrated into research practices, particularly with the involvement of funding agencies.

CONCLUSION

The utilization of patient and public involvement in Nordic healthcare research has substantially increased, proliferated, and gained widespread acceptance across diverse healthcare domains. The variety of approaches challenged our scoping review in terms of systematic description and impact. Patient and public involvement was applied in one or more research stages using different methodologies and terms. International agreement on terms and definitions is needed for reliable interpretation of the use of patient and public involvement in Nordic healthcare research.

The key values and factors identified by older adults to promote physical activity and reduce sedentary behaviour using co-production approaches: a scoping review

BACKGROUND

Inactivity and sedentary behaviour in older adults adversely impacts physical function, reduces social networks, and could contribute to population healthcare costs. To encourage and support the planning and uptake of physical activity by older adults, it is important to understand what physical activity means to older adults. Therefore, the aim of this scoping review was to collate what older adults have self-identified as the key factors for sustaining and increasing their physical activities.

METHODS

Arksey and O'Malley's Scoping Review framework was used to guide the review process. SCOPUS, ASSIA, PsychINFO and MEDLINE databases were searched. Studies were eligible for inclusion if they were peer-reviewed, the target population were older adults (aged 55 and above), co-production related research approaches were explicitly stated in the methods and there was a focus on design of physical activity interventions or products to support or enhance physical activity. Assets and values important for physical activity were first extracted from included studies and were subsequently thematically analysed. Themes are presented to provide an overview of the literature synthesis.

RESULTS

Sixteen papers were included in the analysis. Data from these papers were gathered via designing interventions or services (n = 8), products (n = 2), 'exergames' (n = 2) or mobile applications (n = 4). Outcomes were varied but common themes emerged across papers. Overarching themes identified by older adults were associated with a desire to increase activity when it was accessible, motivational, and safe. In addition, older adults want to enjoy their activities, want independence and representation, want to stay connected with families and friends, be outdoors, familiarity, activities to be tailored and resulting in measurable/observed progress.

CONCLUSIONS

Population demographics, personal attributes, and life experiences all affect preferences for physical activity. However, the key factors identified by older adults for increasing physical activity were common-even in separate co-production contexts. To promote physical activities in older adults, activities must fundamentally feel safe, provide a sense of social connectedness, be enjoyable and be accessible in terms of cost and ability.

Co-designing implementation strategies to promote remote physical activity programs in frail older community-dwellers

Background

The "AGIL Barcelona (AGILBcn)" community-based integrated care program is a multicomponent healthy aging intervention for frail older adults. In this context, the present study aimed to identify implementation strategies to optimize the accessibility, acceptability, and adaptability of mobile health (mhealth) interventions to enhance physical activity in frail older adults, and to prioritize action points according to their importance and feasibility, through a co-design process.

Material and methods

A mixed methods approach was used. In the qualitative phase, a method adapted from the World Café was applied in 6 virtual groups to identify strategies to facilitate the virtual physical activity program. In the quantitative phase, prioritization and feasibility of the strategies was analyzed through surveys. Strategies were ranked based on priority vs. feasibility, revealing if strategies should either be: implemented first; if possible; taken into account for future consideration; or directly disregarded. The convenience sample included older adults (n = 7), community professionals (n = 9) and health professionals (n = 13). Qualitative data were analyzed by summative content analysis and quantitative data by nonparametric descriptive analyses.

Results

A total of 27 strategies were identified and grouped into four categories: general strategies for reducing barriers; specific strategies for facilitating the use of a digital application; specific strategies for facilitating participation in virtual exercise groups; and specific strategies for facilitating external support. According to the ranking of strategies, the first ones to be implemented included: digital literacy, digital capability assessment, family technology support, weekly telephone follow-up by professionals, personalizing exercises, and virtual exercises in small groups.

Conclusion

The active participation of all stakeholders enabled us to identify potential strategies for implementing person-oriented technology in physical activity programs and for engaging older adults.

Scoping review protocol of the use of codesign methods in stroke intervention development

INTRODUCTION

Codesign is an emerging research method to enhance intervention development by actively engaging non-researchers (eg, people who have had a stroke, caregivers and clinicians) in research. The involvement of non-researchers in research is becoming increasingly popular within health studies as it may produce more relevant and effective findings. The stroke population commonly exhibits challenges such as aphasia and cognitive changes that may limit their participation in codesign. However, the use of codesign within the stroke literature has not been comprehensively reviewed. This scoping review will determine: (1) what is the extent, range and nature of stroke research that has used codesign methods? (2) What codesign methods have been used to develop stroke interventions? (3) What considerations for codesigning interventions with people who have stroke are not captured in the findings?

METHODS AND ANALYSIS

This is a protocol for a scoping review to identify the literature relating to stroke, and codesign will be conducted on OVID Medline, OVID Embase, OVID PsychINFO, EBSCO CINAHL, the Cochrane Library, Scopus, PEDro-Physiotherapy Evidence Database and Global Index Medicus. Studies of any design and publication date will be included. Title and abstract and full-text review will be conducted independently by two reviewers. Data will be extracted, collated and then summarised descriptively using quantitative (eg, numerical descriptions) and qualitative (eg, textual descriptions) methods. Numerical summaries will map the extent (eg, number of studies), range (eg, types of studies) and nature (eg, types of interventions developed) of the literature on this topic. A thematic analysis will provide insights into the codesign methods (eg, activities, non-researchers), including heterogeneity across and within studies.

ETHICS AND DISSEMINATION

This review protocol does not require ethics approval as data has not been collected/analysed. The findings will highlight opportunities and recommendations to inform future codesign research in stroke and other populations who exhibit similar challenges/disabilities, and they will be disseminated via publications, presentations and stakeholder meetings.

TRIAL REGISTRATION NUMBERREGISTRATION

Open Science Framework: 10.17605/OSF.IO/NSD2W.

Development of an intervention to facilitate dissemination of community-based training to respond to out-of-hospital cardiac arrest: FirstCPR

Background and aim

Out-of-hospital cardiac arrest (OHCA) is a significant public health issue with low survival rates. Prompt bystander action can more than double survival odds. OHCA response training is primarily pursued due to work-related mandates, with few programs targeting communities with lower training levels. The aim of this research was to describe the development process of a targeted multicomponent intervention package designed to enhance confidence and training among laypeople in responding to an OHCA.

Methods

An iterative, three-phase program development process was employed using a mixed methods approach. The initial phase involved establishment of a multidisciplinary panel that informed decisions on key messages, program content, format, and delivery modes. These decisions were based on scientific evidence and guided by behavioural theories. The second phase comprised the development of the intervention package, identifying existing information and developing new material to fill identified gaps. The third phase involved refining and finalising the material via feedback from panel members, stakeholders, and community members.

Results

Through this approach, we collaboratively developed a comprehensive evidence-based education and training package consisting of a digital intervention supplemented with free access to in-person education and training. The package was designed to teach community members the specific steps in recognising and responding to a cardiac arrest, while addressing commonly known barriers and fears related to bystander response. The tailored program and delivery format addressed the needs of individuals of diverse ages, cultural backgrounds, and varied training needs and preferences.

Conclusion

The study highlights the importance of community engagement in intervention development and demonstrates the need of evidence-based and collaborative approaches in creating a comprehensive, localised, relatively low-cost intervention package to improve bystander response to OHCA.

Co-designing implementation strategies for the WALK-Cph intervention in Denmark aimed at increasing mobility in acutely hospitalized older patients: a qualitative analysis of selected strategies and their justifications

BACKGROUND

Selecting appropriate strategies to target barriers to implementing interventions represents a considerable challenge in implementation research and practice. The aim was to investigate what categories of implementation strategies were selected by health care practitioners and their managers in a co-design process and how they justified these strategies aimed at facilitating the implementation of the WALK-Cph intervention.

METHODS

The study used a qualitative research design to explore what implementation strategies were selected and the justifications for selecting these strategies. Workshops were used because this qualitative method is particularly well suited for studying co-design processes that involve substantial attention to social interaction and the context. Data were 1) analyzed deductively based on the Proctor et al. taxonomy of implementation strategies, 2) categorized in accordance with the ERIC compilation of implementation strategies by Powell et al., and 3) analyzed to examine the justification for the selected strategies by the Proctor et al. framework for justifications of implementation strategies.

RESULTS

Thirteen different types of implementation strategies were chosen across two hospitals. The deductive analysis showed that selection of implementation strategies was based on pragmatic and theoretical justifications. The contents of the two types of justifications were thematized into nine subthemes.

CONCLUSION

This study contributes with knowledge about categories and justification of implementation strategies selected in a co-design process. In this study, implementation strategies were selected through pragmatic and theoretical justifications. This points to a challenge in balancing strategies based on practice-based and research-based knowledge and thereby selection of strategies with or without proven effectiveness.

Adaptations and modifications to a co-designed intervention and its clinical implementation: a qualitative study in Denmark

BACKGROUND

There is a long-standing debate in implementation research on whether adaptations to evidence-based interventions (EBIs) are desirable in health care. If an intervention is adapted and not delivered as conceived and planned, it is said to have low fidelity. The WALK-Cph project was developed based on the assumption that involving stakeholders in co-design processes would facilitate the fidelity of an intervention to increase the mobility of acutely admitted older medical patients and its implementation in two hospitals in Denmark. The purpose of this study is to describe and analyse adaptations and modifications that were made to the co-designed WALK-Cph intervention and its implementation.

METHODS

This study used a qualitative design. An ethnographic field study was performed using participant observations, workshops and semi-structured interviews. Data were analysed twice using the Framework Method. The first analysis was based on the frameworks from Stirman, Moore and Proctor. The second analysis, a retrospective modifications analysis, was based on the Adaptation-Impact Framework.

RESULTS

Many different types of adaptations and modifications were made to the WALK-Cph intervention and its implementation plan. Most of the modifications were made on the contents of the intervention. In total, 44 adaptations and modifications were made, of which 21 were planned (adaptations) and 23 were made haphazardly (modifications). Most of the content and context adaptations and modifications made on the intervention had a mixed result regarding enhanced fidelity. The retrospective modifications analysis showed that modifications were ongoing and both situationally and contextually shaped.

CONCLUSIONS

Although an extensive co-design process was carried out to facilitate the fidelity of the WALK-Cph intervention, this study showed that many adaptations and modifications were still made to both the intervention and its implementation plan. It could indicate that the co-design process had a small effect or that adaptations and modifications are ongoing and both situationally and contextually shaped, which challenge the assumption and the desire to be able to plan and control changes.